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Anyone aware of bradypnea (slow breathing rate) or CO2 issue?

ryan31337

Senior Member
Messages
664
Location
South East, England
Hi all,

Has anyone had treatment for respiratory issues in relation to their ME/CFS? I'm aware Breakspear clinic have prescribed O2/CO2 therapy to some patients, curious if any here could share their experience?

I've had some awareness of breathing issues over the years, stuff like: excessive yawning & sighing, 'forgetting' to breathe and gasping (both awake & asleep) and odd habits like holding breath and exhaling slowly & forcefully without realising - much to the annoyance of others! A recent positive tilt table test really gave me a clear indication of shortness of breath during pre-syncope too, I had a really dramatic desire to breathe excessively deeply, something I have experienced from time to time previously without associating. I don't think any of this is particularly unusual in ME/OI circles.

However, yesterday I had a CPET and the physiologist couldn't believe that I wasn't actively slowing my breathing, apparently I was doing ~6 breaths per minute during the low intensity phase, which was considerably less than her whilst she was just standing there. I'm generally comfortable breathing 4x times a minute at rest, if I meditate this will drop to 3x or lower. Apparently <12x is Bradypnea...who knew :woot:

I assumed this would just be related directly to dysautonomia in some unhelpful way, but having seen the list of potential causes for bradypnea like hypertension, electrolyte imbalance, hypothyroidism etc. perhaps there's more to be done. Its quite fascinating seeing the implications of low CO2 as well, vasoconstriction, hypoperfusion etc...
 
Messages
35
Location
Tucson, AZ
I've had episodes of inexplicable yawning attacks, air hunger, and pretty consistent bradypnea without forceful exhalation. My breathing tends to especially slow down when I'm laid out with PEM, yet despite not breathing notably deeply, never seems to leave me gasping for air. I wouldn't be surprised if I only do breath 6-8 times per minute on average.

In my case, I also have a heart rate in the 40s most of the time.

Bradypnea, and more likely the autonomics factors that precipitate it, are also associated with central sleep apnea. You describe central sleep apnea in your 2nd paragraph.
 

leokitten

Senior Member
Messages
1,542
Location
U.S.
Hi @ryan31337 yes definitely yes! I just posted on this symptom as I’ve had it since getting ME. My breathing rate is significantly slower than normal and compared to what it used to be. I breathe a lot slower than my spouse and didn’t used to. I don’t have any breathing issues though aside from the ME causing me breathing rate to slow down.
 

pattismith

Senior Member
Messages
3,932
My resting respiratory rate is 6-7 breaths per minute. Far slower than the adult normal of 12-20.

Hello @leokitten

did you investigate your bradypnea issue?

I realised I have bradypnea after I checked my blood gas (I have moderate hypercapnia = high CO2 and my blood bicarbonates are at the higher limit).

My breathing rate is less than 12 (8 to 10 at rest), but it's normal when I take methylphenidate.

Bradypnea and hypoventilation can happen with hypothalamic or brainstem dysfunction, but myopathy can also weaken the respiratory muscles and cause it. In these cases, hypoventilation/hypercapnia lead to a chronic respiratory acidosis with a compensatory increase of bicarbonate by kidneys.

A decrease ability of kidneys to excrete bicarbonate can also be involved , or a compensatory attempt to correct some intracellular acidity. In these two cases, The bradypnea is a compensatory effect for a chronic metabolic alkalosis.

I think for those with breathing anomalies, it's important to investigate all the possible causes and to find it before any event may break the frail compensated pH equilibrium we have.

Up to now, I didn't find any doctor interested in my blood result, but i just recently realised my low breath rate, maybe I will have more chance to get a doc looking into it?

Most of the time docs only get interested when you are in a very bad shape with an acute acidosis or alkalosis, and I wish to avoid it at all cost!

@ryan31337 did you investigate more on this issue? Did you check if you have a kind of breathing abnomaly like these ones:

Cheyne Stokes Breathing and Other Abnormal Respiration (healthline.com)
..
 
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pattismith

Senior Member
Messages
3,932
Interesting to note that in this study (children with central apnea), they didn't find correlation with brainstem anomaly at MRI.

I remember Jen Brea (who was suffering with brainstem compression because of craniocervical instability) was explaining she could experience central apnea when her head was turned in some way.
I wonder if they looked for craniocervical instability?

@JenB


Robert C. Stowe, MD
,
Monica Miranda-Schaeubinger, MD, MSPH
,
Savvas Andronikou, MBBCh, PhD
,
Ignacio E. Tapia, MD, MS

Published Online:July 1, 2021https://doi.org/10.5664/jcsm.9210



Abstract

STUDY OBJECTIVES:

Evaluation of elevated central apnea-hypopnea index (CAHI) or prolonged central apneas in pediatric patients typically includes neuroimaging with a focus on brainstem pathology.
There is little evidence guiding thresholds of polysomnographic variables that accurately predict abnormal neuroimaging.
We sought to evaluate whether additional polysomnographic variables may help predict brainstem pathology.

METHODS:

A 10-year retrospective review of patients ages 1–18 years who received a brain magnetic resonance imaging (MRI) for an indication of central sleep apnea diagnosed via polysomnography was performed. Demographics, medical history, polysomnogram variables, and MRI results were compared.

RESULTS:

This study included 65 patients (69.2% male). The median age was 5.8 years (interquartile range, 3.0–8.3). Most patients had negative (normal or nonsignificant) MRIs (n = 45, 69.2%); 20 (30.8%) had abnormal MRIs. Of the patients with abnormal MRIs, 13 (20.0%) had abnormalities unrelated to the brainstem. Seven patients (10.8%) were found to have brainstem pathology and had a median CAHI of 10.8 events/h (interquartile range, 6.5–21.9), and three of seven (42.9%) had hypoventilation and were more likely to have developmental delay, abnormal neurological examinations, and reflux. Other patients (n = 58) had a median CAHI of 5.6 events/h (interquartile range, 3.1–9.1), and seven (12.1%) had hypoventilation. Area under the curve and receiver operating characteristic curves showed a CAHI ≥ 9.5 events/h and ≥ 6.4% of total sleep time with end-tidal CO2 ≥ 50 mm Hg predicted abnormal brainstem imaging. Prolonged central apneas did not predict abnormal brainstem imaging.

CONCLUSIONS:

Most patients with central sleep apnea do not have MRIs implicating structurally abnormal brainstems.

Utilizing a cutoff of CAHI of ≥ 9.5 events/h, ≥ 6.4% total sleep time with end-tidal CO2 ≥ 50 mm Hg and/or frank hypoventilation, and additional clinical history may optimize MRI utilization in patients with central sleep apnea.
 
Messages
8
I have been a slow breather my whole life. I've also sort of been into meditation for some years. Before I got sick with fatigue and POTS, I was able to focus on the breath because even though it was slow, its was quite constant. Now my breath is soo slow and there are pauses in between breaths that make it impossible to focus on the breath during meditation. At rest I breathe around 5-8 breaths per minute. According to different health sources, normal breathing rates are from 12- 20 breaths pr minute, some state 10 and up. I often feel like I barely breathe and often feel the need to push my body to breathe more. I get obsessed with my breathing because it feels unaturally slow. When I breathe more my airways get sore, my respiration muscles feels weak and I feel asthmatic. When I did a spirometry-test some months ago my slow breathing disturbed the testing and I had to really push myself to breathe more. My lungs were hurting and felt narrow for weeks after this.

I got quite shocked when my blood gas test showed signs of hyper (!)ventilation last year. I talked to my doc about it, and he says that breathing slowly is a good sign because the body does not need alot of oxygen. But why did my breathing rate slow down when I got sick and why does it feel like I need to breathe more? At the same time my blood shows signs of hyperventilation?? I'm so confused.
 
Messages
184
Oxygen saturation is what really matters. I think most managed care will only give you an oxygen generator if your oxygen saturation is 70% or lower, using that thing that clips onto your finger as a measuring device. What's your oxygen saturation when they check it at the clinic?

If you need CPAP that is a different story. Gasping for air when sleeping sounds like textbook sleep apnea. Is your neck 17 inches around or larger? Another textbook sign of sleep apnea is males with big necks.
 
Messages
8
Oxygen saturation is what really matters. I think most managed care will only give you an oxygen generator if your oxygen saturation is 70% or lower, using that thing that clips onto your finger as a measuring device. What's your oxygen saturation when they check it at the clinic?

Isn't It so that oxygen saturation measured by a pulseoximeter reading is of less value than blood gas? Especially with POTS you can get weird readings because of the circulation issues.
Don't know if you asked me or not, but my pulse ox reading are almost always normal and in the upper range.
 
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pattismith

Senior Member
Messages
3,932
@MrsMSJ

how is you bicarbonates level?

Bradypnea can be central (induced by the brain) or a compensatory phenomenon to metabolic alkalosis.

Metabolic alkalosis: Respiratory compensation​


https://iars.org/membership/
Metabolic alkalosis is a very common primary acid–base disturbance associated with increased plasma HCO3. Increased extracellular HCO3 is due to net loss of H+ and/or addition of HCO3.The most common cause of metabolic alkalosis is gastrointestinal acid loss because of vomiting or nasogastric suctioning; the resulting hypovolemia leads to secretion of renin and aldosterone and enhanced absorption of HCO3. Diuretics are another common cause of metabolic alkalosis. Thiazides (e.g., hydrochlorothiazide) and loop diuretics (e.g., furosemide) induce a net loss of chloride and free water, without altering bicarbonate excretion, and can cause a volume “contraction” alkalosis. When metabolic alkalosis is persistent, it usually reflects an inability of the kidney to excrete HCO3. Rare inherited renal causes of metabolic alkalosis exist (e.g., Bartter syndrome). A typical respiratory response to all types of metabolic alkalosis is hypoventilation leading to a pH correction towards normal.
https://www.openanesthesia.org/keywords/metabolic_alkalosis_respiratory_compensation/
 

Methyl90

Senior Member
Messages
273
@pattismith Sometimes I can't feel my breath, it's as if I have to think about the breathing act. The general state is of hypoventilation. Saturation and blood pressure are normal. B12 and extra methylfolate didn't help like they used to, potassium and magnesium didn't either. What is going on ? low epinephrine / adrenaline ? ferritin and serum iron are normal. I really don't understand if I'm in a state of acid PH (hypercapnia) and alkaline PH.
 
Messages
8
This one is quite interesting when it comes to breathing pattern. Seems like hypocapnia (too little co2) is very common in cfs and that our breathing pattern is dysregulated compared to healthy controls. During exercise we breathed more but also at reduced frequency, very ineffective breathing pattern.

https://www.healthrising.org/blog/2022/06/25/chronic-fatigue-syndrome-gas-exchange-disease/

"Instead of breathing more deeply and rapidly, the ME/CFS group was breathing more deeply and slowly. As noted above the authors suggested that people with ME/CFS may be breathing this way to increase the oxygen flows to their muscles. In other words, the body is trying to compensate for a problem with energy production at the muscle level."